by Michael Smith
It’s time to revisit the touchy issue of gay men and blood donation now that accurate HIV testing is widely available, Canadian researchers argue.
The lifetime ban on giving blood for men who have had sex with other men was justified in 1983 when HIV testing was relatively insensitive but can no longer be supported, according to Mark Wainberg, PhD, and colleagues at Montreal’s McGill University.
In an analysis published online in CMAJ, Wainberg and colleagues urged Canadian authorities to rethink the issue, in the light of better testing for HIV and controversy over what many see as an unfair policy.
Currently, blood is screened for HIV using nucleic acid testing, which is markedly more sensitive than the antibody tests and Western blots introduced in the mid-1980s. Nucleic acid testing also reduces the so-called “window period” in which a person may be unknowingly infected, the researchers said, from three to six months using antibodies to about 12 days.
“We’re still in a time warp,” Wainberg said, “in terms of policy reflecting what we had available to us in 1983 when the policy was formulated.”
Besides, he said, “the policy is discriminatory.”
Replacing the lifetime ban with a shorter period of so-called “donor deferral” might help mitigate shortages in the blood supply, Wainberg, a former president of the International AIDS Society, told MedPage Today.
The issue also has traction in the U.S., where a similar policy is in place.
The American Red Cross has been pushing for “donor deferral policies that are based on current scientific evidence, but at the same time protecting patients from any potential harm,” according to Molly Dalton, a spokesperson for the society. In 2007, the organization unsuccessfully asked the FDA to change the lifetime ban on donations from gay men, she said.
An FDA spokesperson said the agency will revisit the issue in June.
In the CMAJ article, Wainberg and colleagues noted that several industrialized countries, including Argentina, Australia, Japan, and Sweden, have implemented a shorter one-year period of deferral.
If Canada were to follow suit, he said, “we would hardly be leaders.”
The fear is that eliminating the lifetime ban would increase the risk of tainted blood slipping through the test process, the researchers argued. But that fear — justified by events early in the HIV/AIDS pandemic — is no longer realistic, they said.
The researchers noted that a Canadian ban on blood donation by people from Haiti has recently been lifted.
“It’s time for another change in policy,” they wrote.
The researchers suggest that gay men should be required to wait some period of time — a year or more — after starting a new relationship before giving blood. A deferral period of one year or even five years after starting a new relationship would not noticeably increase the residual risk of contaminating the blood supply, the researchers argued.
A one-year deferral, they said, would increase the risk by one unit of blood for every 11 million units collected. A longer period of deferral could also be used, which would reduce the risk still further, they said.
“In diagnostics, nothing is 100% foolproof,” Wainberg conceded.
But he told MedPage Today that other risks are routinely assumed. “Male undergrads in our universities are far more promiscuous than a man in a stable relationship with another man,” but they are routinely allowed to donate blood, he said.
One advantage of ending the ban would be to increase the pool of potential donors. The researchers noted one estimate that a one-year deferral in the U.S. would add 139,000 new donors.
“Gay men used to be among the most staunch donors of blood,” Wainberg said. “One of the tragedies is that, after 30 years, giving blood may no longer be part of gay culture.”
Michael Smith is a MedPage Today North American Correspondent.